Once you have printed and completed the application, take it to the Facilities Support Office at RUH for prox card activation. (NON-Region employees must first pay the $75 fee at the cashier’s office).

Please note: The Saskatchewan Health Authority (Saskatoon and Area) Employee Fitness Centre is available for use by EMPLOYEES AND AFFILIATES, PHYSICIANS, RESIDENTS, ETC. ONLY.

Family members and friends are NOT allowed in the Centre for any reason whatsoever.

*required fields

I am: (check one) *

A new member

Renewing my membership

Home Site - This is the site you will use most often

St. Paul's Hospital

Saskatoon City Hospital

Royal University Hospital

Name *

First

Last

Date *

Employee Payroll # *

Do you currently have a prox card?

Yes

No

Gender *

Male

Female

Department *

Phone (work) *

Home Address *

City/Town *

Postal Code *

Phone (home/cell)

Email *

Fitness Centre Terms and Conditions: (1) Refunds are NOT available for membership fees for any reason. It is the responsibility of the member to advise the Fitness Centre Liaison of unpaid leaves of absence, sick leave, long term disability, etc. (2) Proximity cards will be activated by Facility Management Service office AFTER an orientation to the centre; (3) Fraudulent use of this membership or proximity cards will result in revoked privileges. Proximity cards and memberships are non-transferable. *

SHR Employees: Payment methods are payroll deduction only for SHR employees. This membership does not expire and the employee must cancel their membership or payroll deductions will continue indefinitely.

SHR Affiliates, physicians, residents, etc. A yearly payment of $150.80 by cash, cheque or credit card must be made at the cashier's office. There are no pro-rated fees for those who are on site for shorter duration than 1 year. Memberships must be renewed yearly.

If you answered you are an SHR Affiliate, physician, resident, etc. please indicate your role below:

Payroll Deduction Authorization: I, the undersigned verify that I am an SHR employee and authorize a payroll deduction in the amount of $4.70 per pay period, totalling $122.20 annual membership. SHR Affiliates, physicians, etc. will pay $150.80 in full at cashier's office *

I have read and agree with above statement

SHR Fitness Centre User Waiver Agreement *

I agree that the Saskatoon Health Region (SHR) hereafter called the owner, shall not be liable for, or in any way be responsible for any death, injury, loss, or damage whatsoever that may occur in, on, or about the Fitness Centre premises whether to the applicant/user, its servants, agents, employees, members, guests, patrons, participants, and persons admitted by the applicant, or any other person whatsoever or to the property of any such person, whether caused by negligence or other tortuous acts of the owner or its servants, agents, employees, or anyone for whom it may be responsible, or from any other cause whatsoever and whether such occurs prior to, during or after any usage or event contemplated by this agreement. The owner will not be responsible, or accountable for any damages or loss of equipment that result from any usage, the user will accept and bear sole responsibility for these actions. The owner will not be responsible for loss or damage to personal items and belongings of the applicant/user. It is agreed that the SHR Fitness Centre Terms and Conditions, User Waiver Agreement, and Rules and Regulations shall remain in effect upon all membership renewals.

PAR-Q & YOU: If you are planning on becoming more active than you currently are, answer the seven questions below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start.

Check yes or no for each of the following questions:

Has your doctor ever said that you have a heart condition OR high blood pressure? *

Yes

No

Do you feel pain in your chest at rest, during your daily activities or living OR when you do physical activity? *

Yes

No

Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? (Please answer NO if your dizziness was associated with over-breathing including vigorous exercise. *

Yes

No

Have you ever been diagnosed with another chronic medical condition other than heart disease or high blood pressure? *

Yes

No

Are you currently taking prescribed medications for a chronic medical condition? *

Yes

No

Do you have a bone or joint problem that could be made worse by becoming physically active? Please answer NO if you had a joint problem in the past, but it does not limit your current ability to be physically active. *

Yes

No

Has your doctor ever said that you should only do medically supervised physical activity? *

Yes

No

If you answered NO to all questions above, you are cleared for physical activity. Start slowly and build up gradually. If you answered YES to one or more questions: talk to your doctor BEFORE you start becoming much more physically active. Tell your doctor which questions you answered yes to and find out if its sill okay to be physically active. *

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.